Abstract: Musical hallucinations (MH) have been labeled Oliver Sacks syndrome, and in the majority of cases they occur in the context of a hearing loss. In these instances, they have been described as auditory Charles Bonnet syndrome because they are thought to represent a cortical release phenomenon. Patients with MH tend to have intact reality testing and, as such, the condition may also be described as musical hallucinosis.
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Abstract: Objective: To report a case of paranoid psychosis and cognitive impairment associated with Hepatitis C virus (HCV) antiviral therapy.Methods: Case report.Results: A 55-year-old male presented with paranoid psychosis and cognitive impairment, 4 months after initiating interferon-based HCV antiviral therapy. His psychosis resolved with discontinuation of therapy and initiation of risperidone, but his cognitive impairment persisted.
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Abstract: Objective: To report a case of limbic encephalitis (LE) presenting with psychosis.Method: Case report.Results: A woman with LE initially presented with acute psychotic symptoms. Magnetic resonance imaging (MRI) showed hyperintensity in bilateral temporal lobes. Paraneoplastic and autoimmune antibodies were negative, but symptoms resolved after starting methylprednisolone.Conclusion: A greater awareness for and knowledge of LE among all disciplines could help early recognition and management of LE and avoid permanent behavioral deficits.
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Abstract: Solifenacin-induced cognitive adverse effects have not been reported frequently, but solifenacin-induced delirium and hallucinations with successful switching to darifenacin, without additional drug, have not been reported in the literature. In this case report, we present an 80-year-old Caucasian male with insomnia and anxiety symptoms and overactive bladder who developed delirium and hallucinations when treated with solifenacin and trazodone. After solifenacin discontinuation and switching to darifenacin, symptoms significantly improved immediately.
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Abstract: Objective: The objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises.Method: Participants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order.
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Abstract: Objective: This cross-sectional study considered whether variability in respiratory functioning could explain the variability in walking ability of individuals with schizophrenia taking into account variability in body mass index (BMI), lifestyle factors, psychiatric symptoms, antipsychotic medication use and muscular fitness.Method: Eighty patients with schizophrenia and 40 age, gender and BMI matched controls underwent a spirometry, 6-minute walk test (6MWT) and completed the International Physical Activity Questionnaire. Patients were additionally screened for psychiatric symptoms.Results: Compared to health controls, patients with schizophrenia achieved a lower distance on the 6MWT (583.6±109.7m versus 710.6±108.4m, p
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Abstract: Although hyponatremia has been reported with the use of various antidepressants, the association of hyponatremia with bupropion has been limited to two case reports. In this case report, we present the case of a 75-year-old man who developed hyponatremia with the use of bupropion, which improved with stoppage of bupropion.
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Abstract: Mental disorders occur in as much as 50% of patients with cancer, impairing the oncologic prognosis and quality of life. The diagnostic investigation and treatment planning of this comorbidity impose a clinical challenge once complications related to the neoplasm, such as brain metastasis and paraneoplastic syndromes, must be excluded.
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Abstract: Background: Previous work has suggested significant associations between various psychological symptoms (e.g., depression, anxiety, anger, alcohol abuse) and hypertension. However, the presence and extent of associations between common mental disorders and subsequent adult onset of hypertension remain unclear.
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Abstract: Background: Although depressive disorders are associated with increased health care utilization in the elderly living in high-income countries, few studies have examined this relationship in Latin America.Method: The present study is part of the São Paulo Ageing and Health Study, a population-based epidemiological study of mental disorders in 2072 low-income adults ≥ 65 years old living in São Paulo, Brazil. Depressive disorders defined as major depressive disorder (MDD) and clinically relevant depressive symptoms (CRDS) were assessed with the Geriatric Mental State and the Neuropsychiatric Inventory. We examined the association between depressive disorders/symptoms and health care utilization (outpatient visits, hospital admissions and medication use in the past 3 months) using count models.Results: The prevalence of MDD and CRDS was 4.9% and 21.4%, respectively
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Abstract: Urine retention and voiding dysfunction are infrequent adverse effects in second generation antipsychotics. We present a male patient who developed voiding difficulties after aripiprazole treatment. Close follow-up of a patient after initiating aripiprazole treatment is critical
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Abstract: Mephentermine misuse or dependence has been rarely reported in the literature. This is surprising as mephentermine bears a close structural similarity to methamphetamine.
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Abstract: While clinicians are familiar with psychosis as a complication in the long-term treatment with amantadine, rapid psychiatric complications are of much less concern. In the case presented, severe decompensation in mental status occurred within 48 h of initiation of standard doses of amantadine hydrochloride. Clinicians should be alert not only for delayed complications but also for early-onset mental decompensation in elderly patients with influenza A treated with amantadine.
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Abstract: Clozapine-induced fever has been reported frequently, but clozapine-induced elevated serum C-reactive protein (S-CRP) over 100 mg/L with early onset, without associated myocarditis, has not been reported in the literature. In this case report, we present a case of an 80-year-old Slovenian female with dementia and psychotic symptoms who developed elevated S-CRP (122 mg/L) and fever (38.2°C) on the seventh day with 25 mg of clozapine daily, which improved after clozapine discontinuation.
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Abstract: Objective: This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization.Method: This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization.Results: Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36)
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Abstract: There is considerable literature on the neuropsychiatric effects of antiretrovirals. This is the first case, to our knowledge, of new-onset obsessive–compulsive symptoms correlated with emtricitabine/tenofovir, a commonly prescribed HIV prophylaxis combination. We describe the case of a woman, who developed upsetting obsessive thoughts following initiation of this pharmacotherapy and include discussion of relevant literature.
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Abstract: Although there have been reported fatalities associated with clozapine-induced bowel infarction, in all of these cases, the patients had taken clozapine for months to years.We present here the case of a 47-year-old single man who died suddenly due to bowel infarction and sepsis 1 week after taking clozapine.
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Abstract: Objective: Female sexual hormones (estrogens and gestagens) may affect neurocognitive functioning and mood. Thus, the use of oral hormonal contraceptives (OHC) bears the risk of psychiatric adverse drug reactions such as depression and psychosis.
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Abstract: Objective: The safety of concurrent mood stabilizers during the course of electroconvulsive therapy (ECT) is yet to be clearly established. Delirium with concurrent administration of ECT and lithium carbonate is described in this case report.Methods: A 30-year-old male with a past history of significant head injury developed delirium during the course of bitemporal ECT.Results: The clinical picture and the details of the cognitive impairment have been discussed in the report with a focus on relationship between the lithium carbonate administration and the concurrent ECT.Conclusion: Patients with preexisting organic brain damage could be prone to develop the cognitive adverse effect while on a combination of lithium and ECT.
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Abstract: Aim: To assess the incidence, prevalence, risk factors and outcome of delirium in patients admitted to a cardiac intensive care unit (ICU) of a tertiary care hospital.Methods: Three hundred nine consecutive patients admitted to a 22-bed coronary care unit were screened for presence of delirium by using Confusion Assessment Method for Intensive Care Unit (CAM-ICU), and those found positive on CAM-ICU were further evaluated by a psychiatrist to confirm the diagnosis of delirium as per DSM-IV-TR criteria. Patients were also evaluated for the risk factors for delirium and outcome of delirium.Results: Incidence rate of delirium was 9.27%, and prevalence rate was 18.77%. The risk factors identified for delirium in binary logistic regression analysis were hypokalemia, Sequential Organ Failure Assessment score, presence of cognitive deficits, receiving more than three medications, sepsis, hyponatremia, presence of cardiogenic shock, having undergone coronary artery bypass grafting, left ventricular ejection fraction
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Abstract: Objective: To explore the frequency of different motor subtypes of delirium in children and adolescents and to study the relationship of motor subtypes with other symptoms, etiology and outcome of delirium.Methods: Forty-nine consecutive patients, aged 8–19 years, diagnosed as having delirium as per DSM-IV-TR were assessed on Delirium Rating Scale-Revised 98 (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS), delirium etiology checklist and risk factors for delirium. Different motoric subtypes of delirium were compared with each other for symptoms of delirium as assessed by DRS-R-98, risk factors, etiology and outcome.Results: More than half (53%) of patients were classified as having hyperactive delirium, this was followed by the mixed (26.5%) and the hypoactive (16%) subtype. When the different subtypes were compared with each other, the 3 motor subtypes did not differ from each other in terms of frequency and severity of other symptoms except for minor differences
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Abstract: Objective: To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them.Method: Systems engineers collaborated with staff at an integrated primary care–mental health care clinic to create a computer simulation that mirrored how the clinic currently operates. We then simulated hypothetical changes to the staffing to understand their effects on percentage of patients seen outside scheduled clinic hours and service completion time.Results: We found that, out of the change options being considered by the clinic, extending daily clinic hours by two and including an additional psychiatrist are likely to result in the greatest incremental decreases in patients seen outside clinic hours and in service time.Conclusion: Simulation in partnership with engineers can be an attractive tool for improving mental health clinics, particularly when changes are costly and thus trial-and-error is not desirable.
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Abstract: Objectives: We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.Method: Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.Results: Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P
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Abstract: Objective: Constipation is often overlooked in patients with schizophrenia. We examined their awareness of constipation and whether they reported it to their psychiatrists.Method: Five hundred three inpatients with schizophrenia (International Classification of Diseases, 10th Revision) were interviewed about their recent bowel movements and evaluated for the diagnostic criteria for functional constipation. If constipation was present, patients were asked if they were aware of it and had reported it to their psychiatrists in charge
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Abstract: Objective: This study investigates the prevalence of lithium use, monitoring practice and associated effects on renal function in a large UK community sample.Method: A large population-based renal function database was cross-referenced with a general practitioner database of 404,673 patients. The renal function of patients prescribed lithium during the 2-year period was compared with that of matched controls. The renal monitoring patterns of these cases were investigated in a naturalistic observational study
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